Healthcare Provider Details

I. General information

NPI: 1396235495
Provider Name (Legal Business Name): ALEEYA LISA ENSIGN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 BROADWAY STE 6
SOMERVILLE MA
02144-1703
US

IV. Provider business mailing address

2 MOUNT VIEW AVE
AUBURN MA
01501-2313
US

V. Phone/Fax

Practice location:
  • Phone: 781-312-0252
  • Fax:
Mailing address:
  • Phone: 703-615-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: